The DSM process requires balancing many competing needs, which is always the case when formulating new nomenclatures. The process also entails extensive, unpaid collaboration among a group of experts with different backgrounds and perspectives. Scientific controversies arose and received responses (see references 2, 47, and 209–211). Conflict of interest could undermine confidence in the work group’s recommendations (212), but in fact, as monitored by APA, eight of the 12 members received no pharmaceutical industry income over the 5 years since the work group was convened, two received less than $1,200 and two received less than $10,000 (the APA cap) in any single year. Some individuals assume that financial interests advocated directly to the work group (e.g., pharmaceutical companies, alcohol and tobacco industries, insurers, and providers). Actually, this never happened. While such advocacy could have occurred surreptitiously through unsigned DSM-5 web site comments, few comments stood out as particularly influential since they covered such a wide range of opinions. An exception to this was the web site advocacy of nonprofit groups to include neurobehavioral disorder associated with prenatal alcohol exposure (taken
